Case study Initial history 27yearold female comlaining of sy

Case study

Initial history

27-year-old female comlaining of symptoms of urgency to urinate, frequent urination, and urethral burning during urination persisting for 48 hours

Patient awoke from sleep with urgency and suprapubic discomfort 2 nights ago

Urine now has strong odor and cloudy appearance

Additional history

Recurring urinary tract infections since she married at age 22 years

Prior UTI associated with similar symptoms

Denies history of febrile or hemorrhagic UTI

Three episodes over past 2 years

May be associated with strenuous physical exertion and sexual intercourse

No other medical history

She reports an allergy to penicillin which causes a “rush” and “trouble breathing”

Physical examination

Well-nourished female experiencing mild discomfort

Tenderness on palpation of abdominal pelvic area; physical examination otherwise unremarkable

T=98.6°C orally; BP=114/64 mmHg; P=68; RR=12

Laboratory results

Dipstick urinalysis:

Color: Dark yellow, specific gravity=1.030, pH=6.5

Protein: Negative, glucose: negative, Ketone: negative, bilirubin: negative

Trace occult blood

Leukocytes:large amount

Nitrates: positive, urobilinogen:negative

Microscopic examination:

WBC: too numerous to count (TNTC)/HPF (high power field)

Bacteria: TNTC

RBC: 3 or 4/HPF

Casts: negative

Urine culture:

E.Coli:> 104 CFU/mL

Organism sensitive to ampicillin, nitrofutantoin, trimethoprim-sulfamethoxazole (TMP-SMX), ciprofloxacin, cephalexin

What is the history of this patient?

Solution

The organism is sensitive to antibiotics like ampicillin, nitrofutantoin, trimethoprim-sulfamethoxazole (TMP-SMX), ciprofloxacin, cephalexin. The urine culture shows high number of E.coli present in the urine with 3-4 RBC. Also the WBC is too numerous to count . An initial increase in WBC is indicative of an infection and with such high amount of bacteria in urine , is indicative of a bacterial infection , specifically caused by E.Coli. Although, the urine analysis do not show anymore anomalies, except presence of nitrates. Nitrates in urine occur are also indicative of an urinary tract infection.

The initial patient history is also suggestive of an Urinary tract infection, due to cloudy appearance of urine. The indication is of a Cystitis, which is generally caused by an E.coli in the urine . One of the reasons of the recurring urinary infections might be due to sexual intercourse or strenuous activities.